DL Open Thread: Sunday, October 1, 2023
Feds Look To Shut Down Medicare Advantage Scam. Oh, it’s legal, and the insurers behind Medicare Advantage use it to reject claims:
“How could they make a decision like that without ever coming and seeing me?” said Sullivan, 76. “I still couldn’t walk without one physical therapist behind me and another next to me. Were they all coming home with me?”
UnitedHealthcare — the nation’s largest health insurance company, which provides Sullivan’s Medicare Advantage plan — doesn’t have a crystal ball. It does have NaviHealth, a care management company it bought in 2020, and one of several businesses that use predictive technology to help insurance companies make coverage decisions.
Its proprietary “NH Predict” tool sifts through millions of medical records to match patients with similar diagnoses and characteristics, including age, preexisting health conditions and other factors. Based on these comparisons, an algorithm anticipates what kind of care specific patients will need and for how long.
But patients, providers and patient advocates in several states said they have noticed a suspicious coincidence: The tool often predicts a patient’s date of discharge that coincides with the date their insurer cuts off coverage, even if the patient needs further treatment that government-run Medicare would provide.
Just another piece that John Carney won’t read. But you should.
Speaking Of Which–Biden’s Medicare Trustee Nominee Has Ties To, You Guessed It–Medicare Advantage. Sen. Warren blows the whistle:
Sen. Elizabeth Warren on Thursday grilled President Joe Biden’s pick to fill a vacant spot on the boards that oversee Social Security and Medicare’s finances, highlighting the nominee’s position at a private health insurance company that relies heavily on expensive and fraud-ridden Medicare Advantage plans.
During the Senate Finance Committee’s confirmation hearing for Demetrios Kouzoukas—who previously served in former President Donald Trump’s Health and Human Services Department—Warren (D-Mass.) said she has serious concerns about the nominee’s conflicts of interest, pointing specifically to his role on the board of Clover Health.
Citing the company’s most recent filing with the Securities and Exchange Commission, Warren noted that the firm “receives a ‘substantial portion’ of its total revenue from Medicare Advantage premiums.”
Warren pressed Kouzoukas on how much he gets paid for his work at Clover Health and on whether he plans to leave the board if confirmed as a public trustee for the Social Security and Medicare trust funds.
After repeatedly dodging, Kouzoukas pointed to a letter he received from Warren ahead of Thursday’s hearing. The letter states that Kouzoukas “received compensation of more than $100,000” from Clover in 2022. (‘…more than $100,000’…care to be more specific?)
The letter also notes that Kouzoukas owns 25,000 shares of Clover stock.
Kouzoukas would not commit to leaving the Clover board if he’s confirmed by the Senate.
Withdraw this fucking nomination now, Joe. And fire the person who recommended him.
Meet Menendez’ Meat Maven. Ridicule alone should hasten his resignation:
Just five years ago, Wael Hana was reeling from a string of bad business deals in New Jersey, having tried to launch a truck stop, an Italian restaurant, a limousine service and other companies without ever hitting it big.
Then, his friend started dating Senator Robert Menendez of New Jersey, one of the most powerful Democrats in the United States Senate. Soon, Mr. Hana introduced Mr. Menendez, the chairman of the Senate Foreign Relations Committee, to a growing circle of Egyptian officials, and Mr. Hana’s fortunes took a remarkable turn: He won sole control over certifying all halal food being imported into Egypt, earning enough money to bribe Mr. Menendez with gold bars and wads of cash, prosecutors said.
Mr. Hana, Mr. Menendez and others are now facing charges in what prosecutors have described as a wide-ranging corruption scheme — one that threatens to put an end to the senator’s five decades in politics. But the allegations, if true, also raise a pressing question about Mr. Hana: Was he an agent of the Egyptian government all along, or just a lucky opportunist who stumbled into a position of international influence?
Halal Hanky-Panky. I like it.
The Case Of Sarah Huckabee Sanders And The $19,000 Missing Lectern. What’s that about ‘absolute corruption corrupts absolutely’?:
The controversy concerns the $19,000 purchase of a lectern (or podium) by the governor’s office from an out-of-state events company earlier this year, as well as Gov. Sarah Sanders’ successful efforts to newly block access to certain governmental records.
Sanders recently pushed the state legislature to write a new exemption into the Arkansas FOIA in an attempt to prevent Matt Campbell, the Little Rock lawyer behind the Blue Hog Report blog, from accessing those records. Campbell’s FOIA requests uncovered the lectern purchase to begin with. (Governors just love to block FOIA access, don’t they, John?).
Campbell’s quest to uncover documents about government spending, and his subsequent lawsuit when Arkansas State Police attorneys denied him access to those documents, drove the governor and her supporters to seek a rollback of Arkansas’s longstanding government transparency law earlier this month.
Oh, it gets better. To their credit, some R lawmakers are demanding information as well:
On Thursday, (R State Rep.) Hickey requested an audit into the purchase of that $19,000 lectern, bought from Virginia Beckett, one of Sanders’ longstanding consultants and owner of D.C.-based Beckett Events LLC, which identifies itself as “a full service events management company.”
Hickey also wants an audit on records and information newly removed from public purview thanks to a change in the FOIA. Earlier this month, lawmakers voted to shield the governor’s travel- and security-related receipts and records in perpetuity. The new exemption to the FOIA is retroactive to June 2022, six months before Sanders took office.
The governor’s retroactive power to withhold what’s always been public information, combined with the controversial lectern purchase, bear looking into, Hickey said yesterday.
Just one more detail before I move on:
Fanning the flames was news that Beckett and her business partner, Hannah Stone, helped organize the Jan. 6 rally at the Ellipse in Washington, D.C., which was basically the pep rally for a rebellious rightwing horde to mob the U.S. Capitol.
Beckett’s and Stone’s presence in Paris in June, at the same time Sanders was there, ostensibly on state business, sparked speculation that the $19,000 paid not for a lectern, but for a European trip. (With the governor’s travel records now retroactively off the table for journalists and the public to review, it’s hard to know.)
We knew her. We hated her. We were right.
MAGAt ‘#Me Too’ Opponent Accused Of Killing Fiancee. Evidence looks pretty, um, air-tight:
A former San Francisco Republican official who claimed to be a victim of the #MeToo movement has been accused of dismembering his fiancee.
On 6 September, Alameda, California, officials arrested the 42-year-old Navy veteran Joseph C Roberts after DNA evidence from the autopsy of Rachel Elizabeth Imani Buckner, 27, allegedly pointed in his direction.
Earlier this summer, Buckner’s remains were found inside a bag along the shoreline near the Bay Farm Island bridge, authorities announced in a press release. Buckner’s body, which was missing its head, hands and feet, was found wrapped in black trash bags and duct tape, according to the Mercury News, which reviewed court documents.
On 30 August, following further DNA examinations, Roberts’s DNA was reportedly found on the duct tape and trash bags. A week later, police appeared at an apartment in Pleasanton where Roberts and Buckner lived.
Roberts, a Georgia native, attended Savannah State University in 2009. Years later, he claimed in several interviews that he had been wrongly accused of sexual harassment and suspended from the university.
Roberts’s claims were touted by Donald Trump’s former education secretary Betsy DeVos, who in 2020 rolled back Obama-era guidance on campus sexual assault, which gave further protection to those accused.
In a 2020 op-ed in USA Today, Roberts said that his story “followed what I have since learned in an all-too-familiar pattern for the falsely accused: isolation from friends and family, loss of reputation, depression, substance abuse, suicide attempt”.
Too bad the suicide attempt, if there was one, failed.
What do you want to talk about?
AOC Would Vote Against McCarthy. “We don’t give our votes for free.” I agree:
https://www.politico.com/live-updates/2023/10/01/congress/aoc-wont-save-mccarthy-00119334
Agreed, but it’s not a junior rep’s place to make this kind of pronouncement
Something tells me that it’s not your place to comment on this blog.
This is the same “tail wagging the dog” nonsense that has thrown the Republican Party into disarray and has sent them further right. The democrats need to act in unison. I think they are in a really strong position, but any deal that gets cut will necessarily happen behind closed doors. I agree with the sentiment but not the delivery
Bullshit. You know that someone’s a troll when they trot out the ‘false equivalency’ between AOC and the likes of Jim Jordan, Matt Gaetz, or just name your fave example of Rethuggery.
John Carney and, likely, Hillary Clinton would be right there with you, though…
Oh come on. Congresscritters of both parties are quoted every day. Nobody has contradicted her, so there’ no “disarray.” You’re concern trolling.
Effective January 1st, Christiana Care will become out of network for Humana Medicare Advantage coverage. Anyone who has Humana will need to switch providers during the open enrollment period later this month, if they plan to use Christiana Care physicians or facilities from January onward.
They should be honest and call it Medicare Disadvantage, as the only “advantage” is to insurers.
And yet the Carney administration representatives on the the SEBC committee continue to argue for Medicare Advantage and do away with the current Medifill supplemental plan.
Matt Meyer has said he will protect Delaware retirees current health plan. Speaking to RISE supporters outside of legislative hall he said health care is a basic human right.
At this point I wish the media would ask every legislator what their position is on the issue. It affects over 30,000 current retirees as well as every state employee.